Vocal fold paralysis is one of the most life-changing conditions an ENT specialist can treat, not only because it affects a person’s voice, but because it impacts breathing, swallowing, and overall quality of life. At AOO | ENT Specialists of the Rockies, helping patients regain their voices is a powerful part of why our team is passionate about otolaryngology. Fortunately, today’s treatments offer real, often immediate improvement, including minimally invasive vocal fold injections that can dramatically restore vocal strength.

Understanding Vocal Fold Paralysis

Your vocal folds (commonly called vocal cords) are two small muscles that open when you breathe and come together when you speak. When one or both folds become paralyzed, they may no longer move properly, causing significant strain on the functioning side and reducing the ability to create sound.

 Patients often notice:

• A breathy, weak voice
• Low volume or difficulty projecting
• Shortness of breath, sometimes severe enough to make climbing stairs difficult
• Swallowing problems, including coughing or choking on liquids
• Aspiration, which can increase the risk of lung infections and unintentional weight loss

Even a single paralyzed vocal fold can dramatically impact daily life. That’s why prompt diagnosis and treatment are so important.

Common Causes and Unexpected Triggers

There are several reasons vocal fold paralysis may develop, and many relate to procedures near the nerve that controls vocal movement. Thyroid surgery, parathyroid procedures, and cardiothoracic surgeries are among the most common causes because the recurrent laryngeal nerve may be stretched, bruised, or accidentally injured during the operation.

Some patients experience paralysis after a viral illness, a situation known as idiopathic paralysis, where the exact cause remains unclear. Tumors along the nerve controlling the vocal folds, though this is only one of several possible explanations. In other cases, placement of a breathing tube during surgery or emergency care may contribute to paralysis if the tube is inserted with difficulty or excessive force.

How Vocal Fold Paralysis Is Diagnosed

A proper diagnosis requires a functional evaluation of the vocal folds, which means the physician must see how they move during breathing, speaking, and swallowing. 

While patients may arrive with CT scans or swallow studies, these tests alone cannot confirm paralysis. The gold standard is a laryngoscopy performed in the office using a small camera passed through the nose to observe the folds in real time. 

Treatment Options and How They Are Chosen

Treatment for vocal cord paralysis typically progresses from conservative to more advanced options, depending on how long the paralysis has been present and how significantly it affects quality of life. 

Because nerve function can return over time, ENT specialists often observe patients for several months to a year to evaluate for spontaneous recovery. During this period, temporary treatments such as vocal fold injections can provide immediate and meaningful relief. These injections, most commonly made of hyaluronic acid, act as plumping agents that push the paralyzed fold closer to the midline, allowing the functioning fold to meet it and produce stronger, clearer sound. Injections can be performed in the office or in the operating room, though most patients prefer the convenience and comfort of an in-office procedure.

If paralysis persists and symptoms remain significant, a permanent surgical solution such as thyroplasty may be recommended. This outpatient procedure is done with the patient awake so the surgeon can adjust the implant in real time by listening to the patient’s voice. Through a small incision in the front of the neck, the surgeon creates an opening in the cartilage and places an implant that pushes the paralyzed fold into better alignment. Most patients experience an immediate improvement in vocal strength and swallowing.

What to Expect During Recovery

Recovery after vocal fold injections is straightforward, and most patients return to daily activities the same day. The voice may feel strained or tight for about one week because the fold is intentionally over-injected to ensure lasting benefit. 

After thyroplasty, patients may choose to stay for short observation, and a small drain is removed shortly afterward. Discomfort is usually mild and managed with Tylenol or ibuprofen. While heavy lifting is restricted during healing, everyday conversation is encouraged, and no voice rest is required.

Why Early Treatment Matters

When it comes to treatment, timing plays an important role in long-term outcomes. Research shows that early intervention can help maintain muscle tone and prevent long-term atrophy of the vocal fold. This can lead to more natural voice function and better results, even if permanent treatment is required later. 

While not all cases can be prevented, patients can protect their vocal health by managing reflux, staying hydrated, avoiding excessive vocal strain, and seeking evaluation quickly after any sudden change in voice or swallowing.

Compassionate Care at AOO | ENT Specialists of the Rockies

Vocal fold paralysis can be alarming, especially when it changes how you speak, breathe, or swallow. But with today’s advanced treatments, patients can experience remarkable improvement. 

The team at AOO | ENT Specialists of the Rockies is committed to helping you regain comfort, confidence, and vocal strength. If you’re experiencing sudden voice changes or difficulty breathing or swallowing, we’re here to guide you toward personalized, effective treatment that restores your quality of life. Contact us today to schedule your consultation. 

Pratima Agarwal, MD

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Pratima Agarwal, MD, is a fellowship-trained laryngologist specializing in the care of voice, airway, and swallowing disorders. She completed her Laryngology Fellowship at the Cleveland Clinic after Otolaryngology–Head & Neck Surgery residency at Boston University Medical Center, where she served as Administrative Chief Resident and held a faculty appointment as Clinical Instructor of Otolaryngology. Dr. Agarwal earned her MD from the Boston University Chobanian & Avedisian School of Medicine and a BA in Neuroscience from Boston University.

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